The Ottumwa Courier

Wapello County

March 28, 2013

Officials promote Medicaid expansion

OTTUMWA — The only logical choice to replace an expiring health care system is to expand Medicaid, supporters say.

Healthiest Iowa Initiative held a “Medicaid Madness” tour throughout the state on Wednesday, discussing Medicaid expansion as a result of the Affordable Care Act and asking Gov. Terry Branstad to support it.

Rick Johnson, executive director of River Hills Community Health Center; Cheryll Jones, regional director of the University of Iowa Specialized Child Health Clinic; and Steve Siegel, president of the Southern Iowa Labor Council AFL-CIO, asked Branstad to consider Medicaid expansion to cover an additional 150,000 Iowans.

Branstad has opposed expanding Medicaid due to a lack of confidence in the federal government to follow through and fund the expansion for the next three years. Instead, he has proposed an alternative, the Healthy Iowa Plan, though specific details have not yet been revealed.

While the Democrat-controlled Iowa Senate approved a Medicaid expansion on a straight party-line vote on Tuesday, it has yet to pass through the Republican-controlled Iowa House, and supporters of the Medicaid expansion don’t have a lot of confidence that it will move to the governor’s desk for approval.

Medicaid expansion is the right choice, supporters said, because it would provide health care services to those at or below 138 percent of the poverty level.

“In this area of the state, that’s a significant portion of the population,” Jones said. “It would offer basic health care and include mental health and substance abuse, important benefits that these individuals need.”

For the first three years, the federal government has told the states it would fund 100 percent of the expansion. After three years have passed, states would foot 10 percent of the bill.

“Instead of Medicaid expansion, [Branstad’s] idea is to keep the IowaCare program with a few enhancements,” Johnson said.

IowaCare gives some health care services to those who are not eligible for Medicaid and who would otherwise have no coverage. There are eight IowaCare providers in the entire state.

In River Hills’ eight-county service area, two counties — Mahaska and Monroe — have to send IowaCare patients to Broadlawns Medical Center in Des Moines, while the other six counties have to send them to University of Iowa Hospitals and Clinics in Iowa City.

“The problem is there are a lot of things that are not currently covered under IowaCare,” Johnson said, which includes transportation, mental health services and medications.

If patients had “full-blown Medicaid,” they would be able to get primary care in their hometown rather than having to find transportation to Des Moines or Iowa City in order to find an IowaCare provider.

“Medicaid expansion would take that whole access issue off the table for people down in southeast Iowa,” Johnson said.

IowaCare is an improvement over the state’s former system, Siegel said, “but it’s certainly not a full-blown health coverage program for folks.

“The vast majority of these people are workers; they’re employed at home health, Walmart, convenience stores, grocery stores full time,” Siegel said. “But they don’t have any benefits. This is probably the only way they’ll be able to get full medical coverage.”

According to Iowa Code, IowaCare will expire at the end of this year — and something has to replace it. But Siegel, Johnson and Jones are not confident that the state Legislature will pass Medicaid expansion.

“It’s very uncertain what’s going to happen here,” Jones said. “In my view, Medicaid expansion is the most realistic and makes the most sense. The bottom line is there are Iowans quite frankly very much at the mercy, if you will, of what happens in the Legislature.”

Siegel said the governor’s plan would force patients to pay more and receive fewer services, as well as cut off services for thousands of Iowans currently under IowaCare.

River Hills is not an IowaCare provider, but there are approximately 3,500 to 4,000 people in its service area that would be eligible “for full-blown Medicaid expansion,” Johnson said.

The two southern tiers of counties in Iowa have always been the poverty belt of the state, Johnson said, “meaning they could be even more negatively impacted” if Medicaid expansion does not pass.

Jones described IowaCare as a “stop-gap system” put in place in 2005, which has been utilized by more than 144,000 Iowans ever since, according to the Iowa Department of Human Services.

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